Coronavirus: Myth vs. Reality
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Executive Summary
It is highly likely that people you know will die from COVID-19.
Less will die if we collectively take urgent worldwide action.
Urgent action requires political will and personal sacrifice.
Political will and personal sacrifice won’t be possible without a shared understanding of the facts.
We have attempted to summarize the facts that have helped us reach our own conclusions for ourselves and our families, and put them in contrast to common myths heard or seen on social media.
We are concerned citizens attempting to strengthen the signal through the noise. All data/graphs used have been cited. ��Xavier Helgesen (@xavierhelgesen), KJ Erickson (@kjer)
Background on sources of data used
From February 16-24, the WHO sent a mission of 25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States of America and the World Health Organization (WHO) to China.
The results are enlightening and clarifying. However, many popular misperceptions remain in the general public.
We have attempted to summarize some of the key findings, along with projections from other sources, to help everyone understand why this is such a big deal and why urgent action is needed by everyone.
All other data is linked to source, and is either directly or summarized from a globally recognized healthcare organization (e.g. WHO, Johns Hopkins).
Source: Johns Hopkins (click for real time update)
Yellow Line = Rest of World Cases
We Are Seeing Exponential Growth Around The World
Myth #1: Isn’t this just like the flu?
Business Insider (based on CDC data)
Reality: EMPHATIC NO.
In all age groups, COVID-19 is 2,000-4,000% more deadly than the flu.
Even if you don’t die, you tie up hospital beds for weeks, which quickly overwhelms the system. 10-20% of cases need treatment in ICU.
(note: We have insufficient data for under 5 years old for COVID-19. The good news is fatality rates seem very low in this age group.)
Myth #1: Isn’t this just like the flu?
Myth #1: Isn’t this just like the flu?
"What we've seen is people are cherry-picking data. So they look at the lowest possible case fatality rates and say, 'Oh look, it's like seasonal flu.' Or they pick, 'Oh it doesn't spread so fast because of this,' or 'Oh it only affects the older ones, I'm safe.' And none of those propositions are true.�
"There's no reason to panic about this disease, but you have to be deeply concerned. This is not seasonal flu. It's an order of magnitude [with] tenfold — at least — higher mortality rate. Yes, it does strike vulnerable populations, but it can strike any age, let's be very, very clear — especially between your 30s and 60s and the older population."
Bruce Aynland
Leader of WHO Mission to China
Myth #2: The death rate is much lower than published
Reality: We don’t have the evidence to support this.
In order for the death rate to be much lower than currently believed (WHO “crude mortality rate” is 3-4%, some writers say 0.5%-2%), there would need to be a large number of undiagnosed cases that have not died (leading to a higher denominator). Here is what the WHO had to say on this conjecture:
“People keep saying [the cases are the] tip of the iceberg. But we couldn’t find that. We found there’s a lot of people who are cases, a lot of close contacts — but not a lot of asymptomatic circulation of this virus in the bigger population. And that’s different from flu. In flu, you’ll find this virus right through the child population, right through blood samples of 20 to 40 percent of the population.”
Bruce Aynland, leader of WHO mission to China
Myth #3: Kids don’t get sick.
Reality: Kids do get the virus, some die, and they may be silently spreading it.
“Kids are just as likely to get infected as adults,” says Justin Lessler, an infectious disease epidemiologist at Johns Hopkins Bloomberg School of Public Health, who co-led the new study with epidemiologists at the Harbin Institute of Technology in Shenzhen and the Shenzhen Center for Disease Control and Prevention.
“We’ve got to get an antibody test [to test the population for antibodies to the virus] to know if kids are driving the epidemic and we just can’t see it.” - Bruce Aynland, leader of WHO mission to China
From the WHO report: “A very small proportion of those aged under 19 years have developed severe (2.5%) or critical disease (0.2%).” It is important to remember that 0.2% is still 1 out of 500. In a 2000 person high school, 37 kids could become severely ill and 3 kids could be expected to die if 75% become infected.
Interview with Bruce Aynland �Wired Article on Study from Johns Hopkins
Myth #4: This isn’t China. Our systems are better.
Reality: Not remotely true. The Chinese did an exceptional job once they took decisive action. Fatality rates are likely to be worse in USA/Europe.
“[In China} they find cases fast, get them isolated, in treatment, and supported early. Second thing they do is ventilate dozens in the average hospital; they use extracorporeal membrane oxygenation [removing blood from a person’s body and oxygenating their red blood cells] when ventilation doesn’t work. This is sophisticated health care. They have a survival rate for this disease I would not extrapolate to the rest of the world. What you’ve seen in Italy and Iran is that a lot of people are dying.”
-Bruce Aynland, leader of WHO mission to China
To understand the incredible scope of the Chinese response to the virus, see this thread by Nicholas A. Christakis (Harvard/Yale MD and Author). 950 Million people had movement restricted.
Myth #5: Worst case, I can be treated in the hospital.
Reality: Hospital beds and health workers are very likely to be quickly overwhelmed in the USA. Death rates will rise quickly after capacity is filled. Only 1 in 80,000 people in the USA can be admitted the ICU before the beds are full.
There are 924,000 hospital beds in the USA. �Of these, there are approximately 46,500 ICU beds.
66% of Hospital Beds are already occupied. 90% of ICU beds are occupied. �That leaves 314,000 beds available, with 4,650 ICU beds.
Only 1 out of 1,000 people in the USA can be hospitalized and� only 1 in 80,000 Americans has a free bed available in the ICU.
https://www.statista.com/statistics/185904/hospital-occupancy-rate-in-the-us-since-2001/�https://www.sccm.org/Communications/Critical-Care-Statistics�https://www.aha.org/statistics/fast-facts-us-hospitals
Myth #5: Worst case, I can be treated in the hospital.
Here is what is happening in a very modern healthcare system in Italy:
Myth #5: Worst case, I can be treated in the hospital.
Source:Eric Toner, MD, and Richard Waldhorn, MD - Johns Hopkins - http://www.centerforhealthsecurity.org/cbn/
https://twitter.com/mims/status/1237084608635830277
Myth #5: Worst case, I can be treated in the hospital.
In Italy, 1 in 10 patients needs to be admitted to the intensive care unit.
Source: WHO Joint Mission Report
Myth #5: Worst case, I can be treated in the hospital.
Medical workers have a huge risk of fatigue, burnout and infection.
China was able to import 40,000 workers to help with its outbreak. This is unlikely in the USA.
Myth #6: Everyone is going to get it anyway.
Reality: Transmission rates dramatically depend on public action and personal choices. China showed the way via unprecedented lockdown measures, same day testing, and meticulous tracking of transmission.
Myth #6: Everyone is going to get it anyway.
Reality: Transmission rates dramatically depend on public action and personal choices. China showed the way via unprecedented lockdown measures, same day testing, and meticulous tracking of transmission.
“In China, they have set up a giant network of fever hospitals. In some areas, a team can go to you and swab you and have an answer for you in four to seven hours. But you’ve got to be set up — speed is everything.
So make sure your people know [about the virus]. Make sure you have mechanisms for working with them very quickly through your health system. Then enough public health infrastructure to investigate cases, identify the close contacts, and then make sure they remain under surveillance. That’s 90 percent of the Chinese response.” - Bruce Aynland, leader of WHO mission to China
Myth #7: It’s not in my area yet
Reality: It will be soon. By the time cases are publicly reported, it is too late.
Recommendations
Self-Isolate for the next 4-8 weeks until we have more information
Perspective on how to prepare in Scientific American: https://blogs.scientificamerican.com/observations/preparing-for-coronavirus-to-strike-the-u-s/
“Preparing for the almost inevitable global spread of this virus, now dubbed COVID-19, is one of the most pro-social, altruistic things you can do in response to potential disruptions of this kind. We should prepare, not because we may feel personally at risk, but so that we can help lessen the risk for everyone. We should prepare not because we are facing a doomsday scenario out of our control, but because we can alter every aspect of this risk we face as a society.”
Thoughtful and exhaustive guide to preparation: �https://theprepared.com/wuhan-coronavirus/
Recommendations
Self-Isolate for the next 4-8 weeks until we have more information
Avoiding large gatherings is not sufficient - you must avoid all social contact.
Here is an account by someone in Seattle who caught it at a house party:
“I had Covid-19 and here is my story. I made this post public out of several requests from my friends who asked me to share. I hope it gives you some good information and peace of mind!
First how easily you can get it. I believe I caught it when attending a small house party at which no one was coughing, sneezing or otherwise displaying any symptoms of illness. It appears that 40% of the attendees of this party ended up sick. The media tells you to wash your hands and avoid anyone with symptoms. I did. There is no way to avoid catching this except avoiding all other humans. 40% of folks were all sick within 3 days of attending the party all with the same/similar symptoms including fever.” - Elizabeth Schneider via Facebook
Recommendations
Self-Isolate for the next 4-8 weeks until we have more information
Some basics on self-isolation:
Recommendations
Test early if you show symptoms.
As of writing (3/9/20), Quest and LabCorp are now able to test for the virus. (the test needs to be ordered by a physician - you cannot just go to their retail locations.)
Most spread of the virus happens in close family or other personal contact.
Test-at-home kits may soon be available.
Wash your hands frequently. Use gloves in public if you go out at all.
While food does not directly transmit the virus (it is a respiratory illness), be careful with any packaging, utensils, etc, as the virus can live on surfaces and then enter through your mucus membranes (eyes, nose). (Source: European Food Safety Authority)
Economic Impacts
It is always helpful to assume a worst-case scenario and be pleasantly surprised when evaluating a black swan event such as this one. These are not predictions, but they are possibilities, as unlikely as they may seem. We are children of summer (11 years since the global financial crisis). Winter is coming.
Supporting Viewpoints
"In the past week, COVID-19 has started to behave a lot like the once-in-a-century pathogen we've been worried about," writes Gates. "I hope it's not that bad, but we should assume that it will be until we know otherwise." - Bill Gates
Thank you.
Feedback to xavier.helgesen@gmail.com and kjerstin@gmail.com